Site Mobile Navigation

A.M.A. Policy Group Backs Needle Exchanges

Lenon Wilson, a longtime heroin addict in Chicago with puffy scars the size of leeches on his arms, climbed into an unmarked silver van and unfurled a paper bag concealing 28 dirty hypodermic needles.

''If the van wasn't here, I'd use the same needle three, four, five times, even when it's dirty and has bacteria running through it, and then I'd use somebody else's when I couldn't use mine anymore,'' said Mr. Wilson, known as Smoky, as he scooped up 33 clean needles in exchange for his 28.

The volunteers for the Chicago Recovery Alliance at this mobile van in Harvey, Ill., 25 miles from downtown Chicago, like to give out a bonus of five to their regulars.

''You get a better hit with a clean needle, and it leaves less of a scar,'' Mr. Wilson said. ''It's more hygienic all the way around.''

It was people like Mr. Wilson that the American Medical Association had in mind yesterday when it joined a growing chorus of voices and called for a change in laws to allow intravenous drug users easier access to clean needles to help block the spread of H.I.V., the virus that causes AIDS.

More than one-third of all new AIDS cases in the nation are caused by contaminated needles or sex with drug users. And drug users now account for the highest rates of new H.I.V. infection -- at nearly twice that of homosexual men.

The medical association had previously ''encouraged'' needle-exchange programs, in which addicts turn in dirty needles in exchange for clean ones. But yesterday, citing an ''urgent public health need,'' it was broader and more emphatic. The association's policy-making House of Delegates, meeting in Chicago, voted overwhelmingly to work with members of Congress to initiate legislation revoking the 1988 ban on Federal financing for needle-exchange programs and to encourage state medical societies strongly to initiate state legislation relaxing drug paraphernalia laws so users can legally buy and possess needles.

''There is more and more evidence that the advantages of needle exchange outweigh the disadvantages,'' Dr. Nancy Dickey, chairwoman of the board of trustees and president-elect of the medical association, which represents half the nation's doctors, said in an interview. ''We're addressing a public health epidemic.''

The association said that if the ban continued to the year 2000, the United States would have failed to prevent up to 11,000 cases of AIDS, including those among heterosexual partners of drug users and their children, at a cost of up to $630 million for medical treatment.

Public health professionals applauded the association, saying that its action, combined with a similar bipartisan resolution from the United States Conference of Mayors earlier this week, could increase pressure on the politically sensitive Clinton Administration and a reluctant, conservative Congress to reverse the Federal ban on financing needle-exchange programs.

In San Francisco, Roslyn Allen, project director at the AIDS Foundation H.I.V. Prevention Project, the nation's largest needle-exchange program, said of the medical association's decision, ''It sends a message to other agencies that still view this as a dark and sinister practice.''

Outside, Allison, a 26-year-old prostitute with bruises on her arm, said the clean needles were safer. Referring to the bad needles she used until recently, she said: ''Works would get clogged, broken and it was pretty common for people to pass them around.''

Dr. Peter Lurie, a researcher at the University of Michigan who is one of the world's foremost experts on needle exchange programs, said the public health benefits of needle exchange had been evident for years.

''If an infection is spread from person to person by an inanimate object, you can prevent it by removing that object,'' he said. ''This is not rocket science.''

But what is obvious to public-health professionals is less clear-cut for politicians.

The medical association's action was greeted coolly in Washington, which remains fearful of putting its official imprimatur on something that many perceive as tantamount to promoting drug use.

Some critics see needle exchange as a foot in the door toward legalizing drugs. They say that the exchange may help addicts avoid AIDS, but that they may die instead of overdoses. Focusing on needle exchange, they argue, takes attention away from treatment.

Beyond that, while many programs offer condoms to those who arrive for clean needles, critics say the needle exchange ignores the vast number of cases of H.I.V. infection that are transmitted through sex. And addicts still need money for drugs, so clean needles do nothing to reduce robberies or violent crime.

One critic of needle exchange is Representative Charles B. Rangel, a Democrat whose Harlem district is home to some of the worst drug-infestations in urban America. Mr. Rangel said needle exchange was acceptable as part of a drug rehabilitation program, but, ''if the budget is just for clean needles, I don't want it.''

When Congress prohibited the spending of Federal money for needle exchange, it said the ban could be lifted only when such programs met two conditions: that they be shown to reduce transmission of H.I.V. and not to increase illegal drug use. The medical association came to just that conclusion yesterday. Previously, numerous studies, including ones by the Federal Centers for Disease Control and Prevention, the National Institutes of Health, the General Accounting Office and the National Academy of Sciences, have generally found that needle exchanges are effective in slowing the spread of H.I.V. and that they have not increased drug use.

But no one in Congress has even tried to lift the ban, and signals from the Clinton Administration, which has the authority to lift the ban, have been cautious.

Dr. David Lewis, director of the Brown University Center for Alcohol and Addiction Studies, said of the mood: ''The Administration is scared. If they move to bring the issue up, Congress will be even more strict and make it harder for addicts to obtain clean needles.''

Representative Jesse L. Jackson Jr., Democrat of Chicago, who supports needle exchange, said the ''demagoguing'' on the issue ''sometimes makes it hard for politicians to vote or do the right or healthy thing.''

But Gary L. Bauer, president of the Family Research Council, a conservative public-policy group, said the collective mind-set in Congress was so opposed to needle exchange that conservatives felt no need to organize against the issue.

''It strikes the average voter in the gut as being against common sense,'' Mr. Bauer said. He said the matter was ''untouchable'' for Mr. Clinton because drug use had gone up on his watch. ''I don't see how this Administration could do anything on this that wouldn't blow up in their face,'' he said.